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In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
Universal Images Group, via Getty Images

A doctor reading the results of a patient’s exercise stress test.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

Many previous attempts to rein in unnecessary care have faltered, but guidance coming from respected physician groups is likely to exert more influence than directives from other quarters. But their change of heart also reflects recent changes in the health care marketplace.

Insurers and other payers are seeking to shift more of their financial pain to providers like hospitals and physician practices, and efforts are being made to reduce financial incentives for doctors to run more tests.

The specialty groups are announcing the educational initiative called Choosing Wisely, directed at both patients and physicians, under the auspices of the American Board of Internal Medicine Foundation and in partnership with Consumer Reports.

The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis — all quite common.

The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease.

Even oncologists are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread, and kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family.

Other efforts to limit testing for patients have provoked backlashes. In November 2009, new mammography guidelines issued by the U.S. Preventive Services Task Force advised women to be screened less frequently for breast cancer, stoking fear among patients about increasing government control over personal health care decisions and the rationing of treatment.

“Any information that can help inform medical decisions is good — the concern is when the information starts to be used not just to inform decisions, but by payers to limit decisions that a patient can make,” said Kathryn Nix, health care policy analyst for the Heritage Foundation a conservative research group. “With health care reform, changes in Medicare and the advent of accountable care organizations, there has been a strong push for using this information to limit patients’ ability to make decisions themselves.”

Dr. Christine K. Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation, disagreed, saying the United States can pay for all Americans’ health care needs as long as care is appropriate: “In fact, rationing is not necessary if you just don’t do the things that don’t help.”

Some experts estimate that up to one-third of the $2 trillion of annual health care costs in the United States each year is spent on unnecessary hospitalizations and tests, unproven treatments, ineffective new drugs and medical devices, and futile care at the end of life.

I had to fire a doctor a couple of years ago. He was convinced that I had congestive heart failure, but had done no tests to confirm that. He was willing to medicate me without tests. He was not interested in my knowledge of my medical history.

When I seized and collapsed last summer from too little sodium in my system, the doctors at the hospital did a lot of tests including my heart. The cardiologist said my heart was in good shape, a little enlarged from my size and athletic routine. They checked my veins in my neck and did some other stuff too.

My mom's doctor has told her than unless she has a specific complaint, he has no intention of battering her body with tests. She's in the miracle zone now, and every invasive test is an opportunity to break the miracle of longevity.

On the other hand, my sister's doctor won't give her meds for her back unless she has a boatload of MRI's which she has to pay cash for.

While you were hanging yourself , on someone else's words
Dying to believe in what you heard
I was staring straight into the shining sun

“Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care,”

“The provision that President Obama refers to is Section 1233 of HR 3200, entitled ‘Advance Care Planning Consultation.’ With all due respect, it’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients,” she continued.

For policymakers and the public, the basic question is not whether there should be rationing in health care: It already exists. Economics itself is an exercise in rationing among goods and services because limited resources cannot purchase unlimited goods. The crucial question is: Who should make the rationing decisions?

The best approach would be to allow individual consumers to make their own decisions about care, including the self-rationing of medical services, by engaging patients in the decisions about their care and its cost throughout their life span and at the end of life. Because such a policy is compatible with American values of limited government, individual liberty and responsibility.

I fired a neurolgist that treated me in a Las Vegas hospital for my stroke. He released to go back to work, made a follow up appointment, his office dropped the ball, and six weeks later, they want to take time off work for tests...no thanks...Both my neurosurgeon and cardiologist said "I don't need the tests." They said the "hold up" was my insurance company, but that was a lie...as I called them...lol My insurance company does not require prior authorization.

I'm having this done in a few weeks, after I heal, I will have an operation from the back of my neck. I had to get firm with this doctor also who was trying to send me to pain mgt. and I pushed for a mylogram which clearly showed the problems.

..................I'm having this done in a few weeks, after I heal, I will have an operation from the back of my neck. I had to get firm with this doctor also who was trying to send me to pain mgt. and I pushed for a mylogram which clearly showed the problems.

This will be done on two discs.

Just wanted to wish you the best of luck. I have known several people who have had similar procedures (OK, it's an operation) done and every one of them came back better than what they considered 100%. They just never realized how restricted they had been.
We even had a dog that had a similar operation, and he came roaring back at 120%!

I fired a neurolgist that treated me in a Las Vegas hospital for my stroke. He released to go back to work, made a follow up appointment, his office dropped the ball, and six weeks later, they want to take time off work for tests...no thanks...Both my neurosurgeon and cardiologist said "I don't need the tests." They said the "hold up" was my insurance company, but that was a lie...as I called them...lol My insurance company does not require prior authorization.

I'm having this done in a few weeks, after I heal, I will have an operation from the back of my neck. I had to get firm with this doctor also who was trying to send me to pain mgt. and I pushed for a mylogram which clearly showed the problems.

This will be done on two discs.

Yes, that looks very serious. Prayers up for you Rob and a speedy recovery.